Provider Demographics
NPI:1659474609
Name:MCCAFFREY, MARY H (MD PHD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:H
Last Name:MCCAFFREY
Suffix:
Gender:F
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83 HERRICK ST
Mailing Address - Street 2:SUITE 2004
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-2757
Mailing Address - Country:US
Mailing Address - Phone:978-927-4800
Mailing Address - Fax:
Practice Address - Street 1:83 HERRICK ST
Practice Address - Street 2:SUITE 2004
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-2757
Practice Address - Country:US
Practice Address - Phone:978-927-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA210563207V00000X
NH15840207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1301853Medicaid
NHP01160788OtherRAILROAD MEDICARE
NH3083953Medicaid
NH32002148Medicaid
NHP01160788OtherRAILROAD MEDICARE
MA1301853Medicaid
NHA3335702Medicare PIN